The following questions concern the symptoms you have experienced due to your shoulder problem. In all cases, please enter the amount of the symptom you have experienced in the last week. (please move the slider on the horizontal line.)

1. How much pain do you experience in your shoulder with overhead activities?

12. How much has your shoulder affected your ability to perform the specific skills required for your sport or work? (If your shoulder affects both sports and work, consider the area that is most affected.)

No pain

Extreme pain

Not affected

Extremely affected

2. How much aching or throbbing do you experience in your shoulder?

13. How much do you feel the need to protect your arm during activities?

No aching/throbbing

Extreme aching/throbbing

Not at all

Extreme

3. How much weakness or lack of strength do you experience in your shoulder?

14. How much difficulty do you experience lifting heavy objects below shoulder level

No weakness

Extreme weakness

No difficulty

Extreme difficulty

4. How much fatigue or lack of stamina do you experience in your shoulder?

15. How much fear do you have of falling on your shoulder?

No fatigue

Extreme fatigue

No fear

Extreme fear

5. How much clicking, cracking or snapping do you experience in your shoulder?

16. How much difficulty do you experience maintaining your desired level of fitness

No clicking

Extreme clicking

No difficulty

Extreme difficulty

6. How much stiffness do you experience in your shoulder?

17. How much difficulty do you have “roughhousing” or “horsing around” with family or friends

No stiffness

Extreme stiffness

No difficulty

Extreme difficulty

7. How much discomfort do you experience in your neck muscles as a result of your shoulder?

18. How much difficulty do you have sleeping because of your shoulder

No discomfort

Extreme discomfort

No difficulty

Extreme difficulty

8. How much feeling of instability or looseness do you experience in your shoulder?

19. How conscious are you of your shoulder

No instability

Extreme instability

Not conscious

Extremely conscious

9. How much do your compensate for your shoulder with other muscles?

20. How concerned are you about your shoulder becoming worse

Not at all

Extreme

No concern

Extremely concerned

10. How much loss of range of motion do you have in your shoulder?

21. How much frustration do you feel because of your shoulder

No loss

Extreme loss

No frustration

Extremely frustrated

11. How much has your shoulder limited the amount you can participate in sports or recreational activities?